Provider Demographics
NPI:1497711709
Name:JAMES, CLIFFORD DALE III (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:DALE
Last Name:JAMES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 OAK RIDGE TPKE
Practice Address - Street 2:STE 120
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7100
Practice Address - Country:US
Practice Address - Phone:865-483-5678
Practice Address - Fax:865-483-4027
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD33918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4035193OtherBLUE CROSS BLUE SHIELD
TN5440527Medicaid
TN4035193OtherBLUECARE TENNCARE
TN4035193OtherTENNCARE SELECT
TNH13280Medicare UPIN